Chapter 15

DENTAL CARIES
Dental caries

 Other term tooth decay

 Worldwide health concern, affecting humans of all ages
 Single most common chronic disease among children, teenagers, and adults (65 and over)
Bacterial Infection

Caries – is an infectious disease, cariogenic oral biofilm, and

a diet with an adequate amount of carbohydrates to
maintain the flora.
- transmissible bacterial infection.

2 Specific Group of Bacteria responsible for caries

1. Mutans streptococci (MS)/ Streptococcus mutans – major
pathogenic, found relatively large number in dental plaque
2. Lactobacilli (LB) – indicates the patient has high sugar intake
Oral Biofilm

 Also known as plaque, dental plaque biofilm or microbial

biofilm
 Colorless, soft, sticky coating made up of communities of
microorganism that adhere to tooth surface. Dental supplies,
restoration of the teeth, the oral mucosa, the tongue and
alveolar bone.
 Microorganism from plaque can cause dental caries, gingival
and periodontal infections

PELLICLE
- adhesive substance where the colonies of bacteria
embedded
Enamel Structure

 Highly mineralized tissue in the body and stronger than bone.

 Consist of microscopic crystal of hydroxyapatite arranged into structural layers or rods,
known prism. H.
 Crystal is surrounded by water and primary teeth are made up of lightly more water than
the permanent teeth
 Water allows the acid to flow into the tooth and minerals to flow out of the tooth.
 Carbonated apatite, a mineral in enamel, makes it easier for the tooth structure to dissolve.
 The Caries Process

Three factors development of caries

1. A susceptible tooth
2. A diet rich in fermentable carbohydrates
3. Specific bacteria (regardless of other factors, caries cannot occur without the presence of bacteria.

Four Areas Carious Lesions To Occur

4. Pit-and-fissure
5. Smooth surface caries
6. Root surface caries
7. Secondary caries or recurrent caries
Stages of Caries Development

 Demineralization – occur when calcium and phosphate dissolve

from hydroxyapatite crystal in the enamel.
 Remineralization – calcium and phosphate are redeposited in
previously demineralized areas.

Two distinct Stages of carious lesions development

First stage – incipient caries, or incipient lesions
- this occur when caries begins to
demineralize
the enamel
Second stage – overt lesion or frank lesion
- characterized by cavitation- the
development of a cavity or
lesion.
Rampant caries – multiple lesions
throughout the

mouth.
- usually
occurs after
excessive and
frequent intake of
sucrose or
affected
by xerostomia
 How to Manage Tooth Decay

 Diet: limit quantities of sugary and starchy foods, snacks, drinks, and candy (three snacks per day)
 Fluorides: fluorides help make the tooth resistant to being dissolved by acids
 Plaque removal: perform thorough brushing and flossing to remove plaque from all tooth surfaces
 Saliva: saliva neutralizes acids and provides minerals and proteins that protect the tooth. After you have had a snack,
chew some sugar-free gum to increase the flow of saliva and neutralize acids. Choose gums that contain xylitol or
baking soda
 Antibacterial mouth rinses: the dentist can prescribe these rinses for patients who are at high risk for caries to reduce
the numbers of bacteria that cause tooth decay.
 Dental sealants: sealants are an excellent preventive measure to be placed on children and young adults who are at risk
for decay
Secondary (Recurrent) Caries

 Caries that starts to form in tiny spaces between the tooth

and the margins of a restoration.
 Difficult to diagnose because it cannot be seen easily and
cannot be detected with an explorer.
 Need radiograph
 Root Caries

 Occur at any age

 As patient age increase, they are more prone to root caries.
 Occurs on the root of the teeth that have gingival recession with exposed root surface.
 Cementum, more susceptible to caries than enamel because it has less mineral content and is more soluble and
therefore more susceptible to caries.
 Factors cause root caries: Taking medication that cause xerostomia (common in age patient)
After radiation therapy of head and neck (normal
salivary flow reduced)
Prevention of Root Caries

 Thorough plaque removal with brushing and flossing

 Nutritional counseling
 Patient education
 In- office and/or prescription fluoride products (containing 5000 ppm)
 Remineralization products that contain calcium phosphate
 For patient with xerostomia, stimulates saliva with the use of sugarless chewing gum or
sugarless candies, or apply saliva substitute, such as gels, sprays, or liquids
Early Childhood Caries (ECC)
 An infectious disease that affects children with constant pain from decayed
teeth and swollen gums
 Another term: Baby bottle tooth decay
 transmissible
 Tooth decay is the single most prevalent disease in children that if left
untreated results in pain and infection.
 Prevention: providing appropriate education for parents and oral healthcare for
the child.
- parents should keep their own teeth healthy in order to keep their
children’ teeth healthy.
- parents should substitute healthy foods and snacks for those that
are sugary, starchy, or sticky
- baby should not place into sleep or nap with bottle milk or
juice
RISK FACTORS:
 Low income families
 Particular ethnic groups
 Limited access to care
 Lack of water fluoridation
Importance of Saliva
Provides:
 physical – enough saliva flow, it provides cleansing effect
 chemical – contains calcium, phosphate and fluoride
 antibacterial – IgA

Saliva Beneficial Actions

• Provides calcium and phosphate for remineralization
• Carries topical fluoride around the mouth for remineralization
• Neutralizes organic acids produced in plaque biofilm
• Discourage the growth of bacteria, inhibiting infection
• Recycles ingested fluoride into the mouth
• Protects hard and soft tissues from drying
• Facilitates chewing and swallowing
• Speeds oral clearance of food
 Caries Diagnosis
 Dental Explorer
- use of the sharp tip of a dental explorer was pressed into an area of
suspected caries, and if it “stuck” it indicate enamel had weakened.
- using a blunt explorer or probe (sharp explorer can possibly cause
cavitation)according to research
 Radiograph Images
- useful for the detection of interproximal and recurrent caries
- early caries on occlusal surface may not be visible on radiograph
 Visual Appearance
- Has range in color: white, brown, or black spots
- Color depends on stage at which decay is in
- Coloring can mimic stains in the pit and grooves from plaque or calculus, coffee or tea,
smoking, medications or vitamins
 Cont.

 Caries Detection Dyes

- provide a visual location of carious dentin.
- dye is supplied in different colors and is applied directly to
the questionable lesion.
- disease area will take on color while area that no caries
will not show the color.
Cont.

 Caries Detection Devices

Laser Caries Detector
- used to diagnose caries and reveal bacterial
activity underneath the enamel surface.
- this does not detect interproximal caries,
subgingival caries, or secondary caries under crowns, inlays,
or restorations.
- can be used to aid in monitoring the progression
or arrestment of caries by comparing a patient’s
reading from visit to visit.
Cont.

Optical Coherence Tomography (OCT)

- a wand-like band piece with a tip is used to scan a tooth.
- with one light source directed at a mirror and the other light source
pointed at the tooth, reflection is created and produces a transmission that is sent to
the receptor.
- the software the creates the image for visualization
- used for evaluation of the eye, has been seen used in dentistry to create
a cross-sectional noninvasive image using light waves.
- beneficial for the diagnosis of caries underneath restorations and
sealants.
-
Caries Assessment Systems

 Developed to help identify the factors that contribute to an increased risk of dental caries
and how to move forward with prevention and treatment
 Following individuals should be assessed based on their specific situation:
• new patient with history of caries activity
• Pregnancy patients
• Patient experiencing a sudden increase in incidence of caries
• Individuals taking medications that may affect the flow of saliva
• Patients with xerostomia
• Patients with upcoming chemotherapy
• Patients who consume high amount of simple carbohydrates based on their food diary
• Patients with autoimmune disease
Caries Management by Risk
Assessment (CAMBRA)
 An evidence-based strategy for preventive and reparative
care for early dental caries that can be used in any dental
office.
 Goal: to assess the risk of caries in an individual.
assess
determine the level of risk of caries (low, moderate,
high, or extreme)
develop an individual preventive plan for each
patient
provides specific products and recommendations to
prevent dental caries
Caries Risk Tests
 Available to detect the numbers of MS and LB bacteria
present in the saliva
 High bacterial counts indicate a high caries risk, and low
counts indicate a low risk for caries.
 Saliva flow rate, a test that measure the amount of saliva in
the mouth in milliliter per minute.
CRT TEST
Caries Risk Test cont.

 CariScreen Caries Susceptibility Test, a simple 1 minute

chairside bacterial test for assessing caries risk
 Using a swab, the plaque is removed from your patient’s
teeth, placed in the meter, and it will provide a score for the
risk of decay